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PubMed2005

Remediation of Bacillus anthracis contamination in the U.S. Department of Justice mail facility.

The U.S. Department of Justice (DOJ) mail facility in Landover, Maryland, was contaminated with Bacillus anthracis spores as a result of the 2001 anthrax bioterrorism attacks through the U.S. postal system. Surface environmental sampling within the facility indicated that the contamination was due to receipt of mail that had come in contact with Bacillus anthracis spores from the source letters at the Brentwood postal facility in Washington, DC. The DOJ adopted a two-pronged approach for remediating the facility, using aqueous chlorine dioxide to decontaminate hard, nonporous surfaces and paraformaldehyde to fumigate two pieces of mail equipment. Before the start of the remediation activities, all porous materials were removed from the mail area. Since all postremediation environmental samples were negative for growth of Bacillus anthracis spores, the remediation was judged to be effective. The facility remained closed for almost 4(1/2) months. The cleanup activities took about 2(1/2) months, with source reduction activities being the most time-consuming. Of the seven facilities that performed fumigations to remediate Bacillus anthracis contamination, the DOJ mail facility was the second building to be reopened.

Anthrax↗
PubMed2005

Postal workers' perspectives on communication during the anthrax attack.

In 2001, the nation experienced its first bioterrorism attack, in the form of anthrax sent through the U.S. Postal Service, and public health professionals were challenged to communicate with a critical audience, U.S. postal workers. Postal workers, the first cohort to receive public health messages during a bioterrorist crisis, offer a crucial viewpoint that can be used in the development of best practices in crisis and emergency risk communication. This article reports results of qualitative interviews and focus groups with 65 postal workers employed at three facilities: Trenton, New Jersey; New York City; and Washington, DC. The social context and changing messages were among the factors that damaged trust between postal workers and public health professionals. Lessons learned from this attack contribute to the growing body of knowledge available to guide communications experts and public health professionals charged with crisis and emergency risk communication with the public.

Adult↗
PubMed2005

Navigating the storm: report and recommendations from the Atlantic Storm exercise.

Atlantic Storm was a tabletop exercise simulating a series of bioterrorism attacks on the transatlantic community. The exercise occurred on January 14, 2005, in Washington, DC, and was organized and convened by the Center for Biosecurity of UPMC, the Center for Transatlantic Relations of Johns Hopkins University, and the Transatlantic Biosecurity Network. Atlantic Storm portrayed a summit meeting of presidents, prime ministers, and other international leaders from both sides of the Atlantic Ocean in which they responded to a campaign of bioterrorist attacks in several countries. The summit principals, who were all current or former senior government leaders, were challenged to address issues such as attaining situational awareness in the wake of a bioattack, coping with scarcity of critical medical resources such as vaccine, deciding how to manage the movement of people across borders, and communicating with their publics. Atlantic Storm illustrated that much might be done in advance to minimize the illness and death, as well as the social, economic, and political disruption, that could be caused by an international epidemic, be it natural or the result of a bioterrorist attack. These lessons are especially timely given the growing concerns over the possibility of an avian influenza pandemic that would require an international response. However, international leaders cannot create the necessary response systems in the midst of a crisis. Medical, public health, and diplomatic response systems and critical medical resources (e.g., medicines and vaccines) must be in place before a bioattack occurs or a pandemic emerges.

Atlantic Ocean↗
PubMed2005

Evaluation of public health interventions for Anthrax: a report to the secretary's council on Public Health Preparedness.

To aid in understanding how best to respond to a bioterror anthrax attack, we analyze a system of differential equations that includes a disease progression model, a set of spatially distributed queues for distributing antibiotics, and vaccination (pre-event and/or post-event). We derive approximate expressions for the number of casualties as a function of key parameters and management levers, including the time at which the attack is detected, the number of days to distribute antibiotics, the adherence to prophylactic antibiotics, and the fraction of the population that is preimmunized. We compare a variety of public health intervention policies in the event of a hypothetical anthrax attack in a large metropolitan area. Modeling assumptions were decided by the Anthrax Modeling Working Group of the Secretary's Council on Public Health Preparedness. Our results highlight the primary importance of rapid antibiotic distribution and lead us to argue for ensuring post-attack surge capacity to rapidly produce enough anthrax vaccine for an additional 100 million people.

Anthrax↗
PubMed2005

Globalizing biosecurity.

A harmonized international regime that enhances biosecurity is needed to reduce the risk of bioterrorism. Like other security regimes, this will entail mutually reinforcing strands, which need to include: enactment of legally binding control of access to dangerous pathogens, transparency for sanctioned biodefense programs, technology transfer and assistance to developing countries to jointly advance biosafety and biosecurity, global awareness of the dual-use dilemma and the potential misuse of science by terrorists, and development of a global ethic of compliance. To work, this effort must be undertaken collectively, utilizing the international and regional institutions that already have a role to play in providing safety and security. Most notably, it must grow in a top-down manner from the Biological Weapons Convention accord, in which States Parties have agreed to ban the development of biological weapons, and in a bottom-up manner from the scientific and health communities, which are engaged in the research and public health efforts that must be protected against misuse-especially involving the World Health Organization.

Bioterrorism↗
PubMed2006

Expression profiling of Yersinia pestis during mouse pulmonary infection.

Yersinia pestis, the causative agent of plague, can be transmitted by infected flea bite or inhaled aerosol. Both routes of infection have a high mortality rate, and pneumonic infections of Y. pestis represent a significant concern as a tool of bioterrorism. Understanding the transcriptional program of this pathogen during pulmonary infection should be valuable in understanding plague pathogenesis, as well as potentially offering insights into new vaccines and therapeutics. Toward this goal we developed a long oligonucleotide microarray to the plague bacillus and evaluated the expression profiles of Y. pestis in vitro and in the mouse pulmonary infection model in vivo. The in vitro analysis compared expression patterns at 27 versus 37 degrees C, as a surrogate of the transition from the flea to the mammalian host. The in vivo analysis used intranasal challenge to the mouse lung. By amplifying the Y. pestis RNA from individual mouse lungs we were able to map the transcriptional profile of plague at postinfection days 1 to 3. Our data present a very different transcriptional profile between in vivo and in vitro expression, suggesting Y. pestis responds to a variety of host signals during infection. Of note was the number of genes found in genomic regions with altered %GC content that are upregulated within the mouse lung environment. These data suggest these regions may provide particularly promising targets for both vaccines and therapeutics.

Administration, Intranasal↗
PubMed2006

PulseNet USA: a five-year update.

PulseNet USA is the molecular surveillance network for foodborne infections in the United States. Since its inception in 1996, it has been instrumental in detection, investigation and control of numerous outbreaks caused by Shiga toxin-producing Escherichia coli O157:[H7] (STEC O157), Salmonella enterica, Listeria monocytogenes, Shigella spp., and Campylobacter. This paper describes the current status of the network, including the methodologies used and its future possibilities. The currently preferred subtyping method in the network is pulsed-field gel electrophoresis (PFGE), a proven highly discriminatory molecular subtyping method. New simpler sequencebased subtyping methods are under development and validation to complement and eventually replace PFGE. PulseNet is essentially a cluster detection network, but the data in the system will now also be used in attribution analyses of sporadic infections. The PulseNet platform will also be used as a primary tool in preparedness and response to acts of food bioterrorism.

Bacterial Typing Techniques↗
PubMed2003

Analysis of historical data suggests long-lasting protective effects of smallpox vaccination.

More than half of the US population has received the smallpox vaccine, but it is unknown what fraction is still protected against infection and disease. Residual protection and age-dependent case-fatality ratios have therefore been widely neglected in the current bioterrorism debate. The author analyzed 1902-1903 data from Liverpool, United Kingdom, and from reintroductions of the disease to Europe in 1950-1971 to estimate to what degree vaccinated cases were protected against developing severe or fatal disease and how quickly this protection waned over time. Protection against severe and fatal disease was lost at the rate of 1.41% per year, corresponding to a half-life of 49.2 years (95% confidence interval: 42.0, 57.3), and protection against fatal disease alone declined 0.363% per year. Thus, even 70 years after primary vaccination, 77.6% of cases were still protected (95% confidence interval: 66.6, 85.4). Protection against severe disease should therefore extend for many decades after a single vaccination, and protection against death from smallpox may even be lifelong for the majority of vaccinees. This protection should greatly reduce the number of severe and fatal cases of disease expected in a bioterrorist attack, but residual protection may also increase the risk that some previously vaccinated cases who develop mild disease may remain unrecognized longer, while moving around freely and disseminating the infection.

Adolescent↗
PubMed2003

Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism.

BACKGROUND: The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness. OBJECTIVES: The aim of the present study was to investigate the impact of this period of tension on patients' first choice for care and for receiving relevant information, and on primary care doctors' feelings of responsibility in the eventuality of an anthrax attack. METHODS: During October 11-31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits. RESULTS: The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines. CONCLUSION: This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.

Anthrax↗
PubMed2005

Understanding health literacy: an expanded model.

A long and yet unfinished history of investigating how individual capabilities and social processes explain or predict health indicates that poor education, low literacy, poor health and early death are strongly linked around the world. However, the complexity of those relationships is not fully understood. In this article, we propose an expanded model of health literacy characterized by four domains: fundamental literacy (reading, writing, speaking and numeracy), science literacy, civic literacy and cultural literacy. To explore the utility of this model, we examine selected pieces of the public discourse about terrorism and bioterrorism that dominated the mass media during the anthrax threat in the United States during 2001. We conclude that this model of health literacy is useful to analyze health communication, to aid in constructing more understandable and appropriate health communication, and ultimately can lead to the development of a new measure to assess health literacy skills in individuals.

Anthrax↗
PubMed2003

What's hot in animal biosafety?

In recent years, the emergence or re-emergence of critical issues in infectious disease and public health has presented new challenges and opportunities for laboratory animal care professionals. The re-emergence of bioterrorism as a threat activity of individuals or small groups has caused a heightened awareness of biosecurity and improved biosafety. The need for animal work involving high-risk or high-consequence pathogens and for arthropod-borne diseases has stimulated renewed interest in animal biosafety matters, particularly for work in containment. Application of these principles to animals retained in outdoor environments has been a consequence of disease eradication programs. The anticipated global eradication of wild poliovirus has prompted the promulgation of new biosafety guidelines for future laboratory and animal work. Increased concern regarding the use of biologically derived toxins and hazardous chemicals has stimulated a new categorization of facility containment based on risk assessment. Recognition that prion disease agents and other high-consequence pathogens require safe handling and thorough destruction during terminal decontamination treatment has led to the development of new biosafety guidelines and technologies. The implementation of these guidelines and technologies will promote state-of-the-art research while minimizing risk to laboratory animals, researchers, and the environment.

Animals↗
PubMed2005

Veterinary medicine in the 21st century: the challenge of biosecurity.

The veterinary profession is presently challenged with developing and maintaining on-farm biosecurity protocols to protect the nation's food supply from acts of bioterrorism, from the growing threat of foreign animal diseases, and from multidrug resistance among pathogenic organisms. This challenge comes at a time when the supply of food animal veterinarians in the United States is progressively in decline, and raises the possibility that the profession is not adequately prepared to fulfill its responsibilities to the health and productivity of the US livestock and poultry populations. Causes of the decline in demand for veterinary services are discussed. They include consolidation of the food animal industries and a trend toward transferring performance of tasks traditionally carried out by veterinarians to the province of lay staff. This development potentially reduces veterinary surveillance of food animal populations. It also runs the risk of delay in recognizing and controlling serious health problems when they arise. Several remedies are proposed, including profound changes in the curriculum for educating food animal veterinarians to serve the consolidated but vulnerable livestock and poultry industries suitably. Also advocated is the initiation of training programs for herdsmen on the symptoms of foreign animal diseases, together with advice on when to call a veterinarian. Significant investment of federal or state resources will be required if these changes are to become reality.

Animal Diseases↗
PubMed2001

The challenges of emerging illness in urban environments: an overview.

The New York City West Nile outbreak is an important case study for examining several medical and public health issues raised by the specter of emerging illnesses in urban areas. Five specific issues are addressed in this issue of the Journal of Urban Health: ecosystem health, vector (e.g., mosquito) control, risk communication, public health infrastructure, and parallels between this outbreak and bioterrorism.

Animals↗
PubMed2003

Food security issues--a potential comprehensive plan.

The need for a comprehensive plan to protect the food production system has emerged as a critical issue over the last several years. To address this need, a comprehensive food security plan has been developed at Auburn University. The proposed program, entitled the Consolidated American Network for Agriculture Resource Intelligence (CANARI) system is one of several systems being proposed to deal with potential agricultural bioterrorism or agroterrorism events. Unlike other systems, which hastily emerged in many agencies after the tragedy of September 11, 2001, the system has been planned over the last 5 yr with the input of the agricultural industries, is comprehensive in its conception, and is designed to coordinate all components (existing and planned) necessary to prevent, detect, and respond to potential agroterrorism events. The plan uses the principle that the first line of defense must be within the states and agricultural companies for the detection of agroterrorism incidents to be rapid and the response effective, organized, and timely. CANARI is designed to integrate the previously disparate elements by fostering a cooperative network of local, state, and federal agencies as well as commodity entities and interested non-governmental organizations. Using a market-driven approach, the system encourages commodity membership and cooperation through positive incentives rather than regulatory duress. A centralized command structure is envisioned, which would be provided through the creation of a National Agroterrorism Defense Center. The responsibility of this Center would be to coordinate all of the activities presently available in components at the local, state, and federal levels and develop and manage new and emerging activities provided by the stakeholders. CANARI offers a new paradigm by which all of its constituent members act collectively and cooperatively to lessen the risk of an attack and better ensure the continued availability of a safe, abundant, and economical food supply.

Agriculture↗
PubMed2002

Terrorism from a public health perspective.

The use of biological and chemical weapons as agents of warfare and terrorism has occurred sporadically, but recent events demonstrate the increasing risk and possibility that terrorist groups with grievances against the government or groups may employ them. Historically, most evaluations of the potential risk for biological weaponry have focused on the military, but the recent release of anthrax in the United States demonstrates that civilian populations are also at risk. More likely than not, most bioterrorism events will be of a small scale; however, agents such as Bacillus anthracis and Yersinia pestis could leave hundreds of thousands dead or incapacitated. The impact of the attack will depend on a number of variables, including the agent used, method of dispersal, and the responsiveness of the public health system. With any large-scale event, the public health infrastructure will be called upon to deal with mass casualties and the "worried well."

Bioterrorism↗
PubMed2002

Unconventional biological threats and the molecular biological response to biological threats.

This article concludes this symposium on potential agents of warfare and terrorism with discussion of 3 topics. First, influenza A virus is discussed as a potential biological weapon. Although it does not receive much attention in this role, the potential for mass casualties and public panic certainly exist if an epidemic of a virulent influenza A virus were initiated. Second, agroterrorism, terrorism directed at livestock or poultry or crops, is briefly discussed. Finally, the potential role of techniques of modern molecular biology to create new agents for bioterrorism or enhance the terrorist potential of available agents, and the known roles of these techniques in defense against biological warfare or terrorism are discussed.

Agriculture↗
PubMed2005

Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies.

The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration.

Allied Health Personnel↗
PubMedDate not supplied

Smallpox as a biological weapon: implications for the critical care clinician.

Once believed eradicated, smallpox has returned as a potential threat. Healthcare providers, as the first line of defense, must be proactive in maintaining current resources and offering input into the preparation for, diagnosis, and management of smallpox should an outbreak occur. The critical care nurse is integral in all aspects regarding smallpox and bioterrorism.

Bioterrorism↗